There are different surgical modalities designed to manage aggressive vertebral hemangioma (VH) that causes neurological symptoms. The selection of the best approach is still controversial. It is crucial to safely achieve neurological recovery with the elimination of the risk of recurrence. The combined use of surgical decompression and vertebroplasty is one of the surgical modalities that are used to manage these cases.
From January 2012 to January 2019, nine patients with aggressive VH were retrospectively included in the study. All of them were operated upon using combined surgical decompression and vertebroplasty. We evaluated all the patients preoperatively, immediate postoperative, 1 month, and 12 months later. Clinical and radiological outcomes were assessed.
Affected spinal levels were dorsal in six cases and lumbar in three cases. There was no postoperative worsening of the preoperative neurological status. For the cases presented with sciatica, the mean VAS score has dropped from 8.33 preoperatively to 2.67 postoperatively. One month later, all of them are free from the radicular pain. For the cases presented with myelopathy, they regain their motor power in both lower limbs over a period of 4 weeks with a mean Nurick grade of 1.17. https://www.selleckchem.com/products/su1498.html The postoperative radiological studies revealed near total occlusion of the VH with the maintenance of the vertebral body height. No clinical or radiological signs of spinal instability or recurrence are observed over the period of follow-up.
The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.
The combined use of surgical decompression and vertebroplasty is considered a safe and effective modality in the management of aggressive VHs.The location of the carotid bifurcation (CB) is highly variable, which makes precise exposure of the cervical carotid artery difficult, especially in transverse incisions. The method for preoperative localization of the CB is not well established. We used the distance from the mastoid-hyoid (M-H) line to the CB, measured preoperatively with computed tomography angiography, to localize the location of the transverse skin incision. We describe and evaluate the accuracy of a method for preoperative localization of the CB for cervical carotid exposure.
The researchers retrospectively evaluated 16 patients with aneurysms arising from the internal carotid artery (ICA) who had received cervical carotid exposure using the localization method of incision and were retrospectively evaluated from February 2018 to November 2019. The method of measurement and localization of the skin incision are described, and two illustrative cases are demonstrated.
Saccular aneurysms of the ophthalmic (C2) segment and communicating (C1) segment of the ICA were found in 8 and 8 patients, respectively. Nine patients had left-sided exposure, and 7 patients had right-sided exposure. The mean distance from the M-H line to the CB was 2.1 cm (range 0.5-3.5 cm). The accuracy of this method was 93.8%. No paralysis of the depressor anguli oris or the depressor labii inferioris was found postoperatively.
The distance from the M-H line to the CB can be used to estimate transverse skin incisions for cervical carotid exposure.
The distance from the M-H line to the CB can be used to estimate transverse skin incisions for cervical carotid exposure.The use of minimally invasive approaches in the management of cerebral aneurysms continues to evolve and a purely endoscopic endonasal approach (EEA) for cerebral aneurysm has its own advantages. The purpose of the present study is to perform a detailed anatomical dissection study to test the usefulness of the extended EEAs for selected anterior communicating artery (ACoA) aneurysm.
Nine human cadaveric heads were used for this study, and all dissections were performed through the endonasal corridor. Endoscopic endonasal surgical dissections were carried out, and surgery was simulated in all specimens to reach the ACoA region. The ACoA complex, its neural and osseous relations, degree of vascular exposure, and the ability to perform clip placement were observed and analyzed.
The transplanum and transtuberculum approaches exposed the A1 and A2 segments of the anterior cerebral artery and the ACoA in all specimens. This route allowed clip ligation of the distal A1 branches, ACoA and proximal A2 branches to the level of the pericallosal segment. Proximal and distal control was most readily achievable at the level of the ACoA complex.
The present cadaveric study on nine specimens with bilateral dissection has demonstrated that the endonasal transplanum transtuberculum approach to the ACoA region provides excellent visualization of the vasculature. When selected prudently, such lesions may be favorable targets for an extended endoscopic endonasal (EEA) in comparison to transcranial approaches that may provide a suboptimal exposure.
The present cadaveric study on nine specimens with bilateral dissection has demonstrated that the endonasal transplanum transtuberculum approach to the ACoA region provides excellent visualization of the vasculature. When selected prudently, such lesions may be favorable targets for an extended endoscopic endonasal (EEA) in comparison to transcranial approaches that may provide a suboptimal exposure.We aimed to analyze the difficulties and complications experienced while as a beginner in endoscopic transnasal transsphenoidal approach for pituitary adenomas.
We retrospectively analyzed 83 cases done from June 2016 to August 2019. Navigation-guided endoscopic transnasal transsphenoidal approach was used in all the cases.
Gross total tumor removal was achieved in 55 (66.26%) patients. We found that gross total resection rate was inversely proportional to Knosp grading, and the extent of resection was found to have a statistically significant correlation with grade of tumor (&lt; 0.05). Surgery-related complications were present in 33 of our patients. Nasal complications occurred in six patients three epistaxis (3.6%) and two hyposmia (2.4%) and one case of septal hematoma (1.2%). Postoperative cerebrospinal fluid leak occurred in six (7.2%) cases, two (2.4%) cases had sinusitis, while two (2.4%) cases had meningitis. There was a very rare case of subarachnoid hemorrhage and one case had sellar hematoma.